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I'd also like to add that ever since in the 70's we discovered that effect for Ibuprofen, a lot of the medicine involved is not just a pain pill, but also a NSAID (Non-Steroidal Anti Inflammatory Drug.) Which is important because of those sleeper nociceptors I was talking about, if the inflammation goes down, some or all of those can get deactivated, so the pain goes down. And anti-inflammatory drugs really don't tend to work THAT part of the magic within an hour. And you kinda have to test against that if any placebo is compared to one of those.
I'll even grant that it might somewhat work at an hour interval, but that's not the thing we're talking about here. We're talking a placebo for surgery, for Pete's sake.
“We” are? No, we are not. I certainly am not. Maybe you are, but I suspect you are alone in that. I’m talking about placebos for managing minor to moderate pain.
You can't ask people in the group that actually got surgery to put the same kind of strain on a shoulder that just got operated, as they did when it hurt before, to see if it already got better.
No ****, Sherlock. Which is why I specifically said that we are NOT talking about affecting underlying damage with a placebo. That was never under consideration by me, and I thought that was obvious.
But even without it involving surgery, a lot of these placebo trials involve comparing stuff across weeks or even months.
Which may be a weakness of those specific studies. But it’s not like all placebo studies have that problem. They don’t.
But generally, even without surgery or even being about pain, the kinds of things that are in placebo trials are not always suited for such immediate comparison. E.g., one such placebo study involved self-reporting how easy it was to fall asleep in patients with insomnia. That's hard to gauge accurately in any case, but more importantly for most people it's going to necessarily mean comparing to something from 24 hours before.
A sleep study that uses self reporting is a bad sleep study, because you don’t need self reporting. You can measure when people fall asleep objectively.
But again, I made no claims about placebos for anything other than pain.
“We” are? No, we are not. I certainly am not. Maybe you are, but I suspect you are alone in that. I’m talking about placebos for managing minor to moderate pain.
Uh, dude, it's in the link in the OP, and it's been quoted and talked about on the first page, etc. So if you want to go "I suspect you are alone in that" kind of smart aleck, no, YOU are the one who only now reveal that you were talking about your own MASSIVELY moved goalposts. In fact, about what seems to be what you just imagined to be the goalposts.
Sorry, it's not MY fault if you want to talk about your own strawman. Try reading the flipping link in the OP before deciding who's alone in talking about what, don't just imagine what everyone is going on about.
Let me put it this way. No one in this thread has advanced the idea that placebos can do anything more than make you feel a bit better. Everyone here is in agreement that it cannot do more than that, and nobody here contests that. And if that's moving the goalpost, it was moved on page 1.
Sorry, it's not MY fault if you want to talk about your own strawman. Try reading the flipping link in the OP before deciding who's alone in talking about what, don't just imagine what everyone is going on about.
I was explicit from the start that I was only talking about pain. You kept bringing up other stuff as if that refuted what I said about pain. That's your straw man, not mine.
Let me put it this way. No one in this thread has advanced the idea that placebos can do anything more than make you feel a bit better. Everyone here is in agreement that it cannot do more than that, and nobody here contests that. And if that's moving the goalpost, it was moved on page 1.
Again, it's in the link in the flippin' OP. As in post #1. As is mentioning the idea of a "powerful placebo effect" more than once. You know, the kind that shows in those multi-week studies. The idea that the very starting post in a thread is moving the goalposts if they don't coincide with what you imagined it's all about, is downright stupid. There were no goalposts before that very first post for it to move.
Edit: *sigh* Look, I'm not going to demand that anyone sticks to the topic, if they feel like discussing some other sub-case or even tangent instead. FSM knows I've gone on all sorts of tangents before myself. But please make it clear we're not talking about the same thing any more. Is all I'm saying.
Er .. paracetamol is not a placebo. It is an actual pain inhibitor. If you are going to deny that there is anything such as a real pain blocker then you will lose all credibility.
Yeah I should have been clearer. If instead of "you take a pill when the pain is worst" you assume I said "you take a homeopathic remedy when the pain is worst" you'll get the gist of what I meant.
Edit: *sigh* Look, I'm not going to demand that anyone sticks to the topic, if they feel like discussing some other sub-case or even tangent instead. FSM knows I've gone on all sorts of tangents before myself. But please make it clear we're not talking about the same thing any more. Is all I'm saying.
I did make it clear. My first non joke post was specifically about pain, nothing more. You responded, asking me specifically about pain. And I responded, still specifically about pain, along with what I thought was a pretty explicit statement that placebos didn’t actually heal you:
But pain IS the experience. The underlying thing being experienced isn't pain, but physical damage. And yes, we know placebos don't affect physical damage to the body. That doesn't mean they don't affect the experience. If you think it affects the experience, guess what? It does. By definition.
So I still don’t know why you ever thought that anything other than pain was being discussed between you and me. That isn’t where it started, and I never brought up any claims beyond that. I was always clear.
Yeah I should have been clearer. If instead of "you take a pill when the pain is worst" you assume I said "you take a homeopathic remedy when the pain is worst" you'll get the gist of what I meant.
Even if a placebo is taken instead, it is not necessarily a coincidence of timing. Depending on the cause of the pain, the belief that the pain is being healed can actually cause a reduction in the pain.
Even if a placebo is taken instead, it is not necessarily a coincidence of timing. Depending on the cause of the pain, the belief that the pain is being healed can actually cause a reduction in the pain.
It can cause a reduction in the perceived pain, without making any objective difference to its cause. Whether that's a meaningful distinction with a purely subjective symptom like pain is, I believe, the question under discussion.
Even if a placebo is taken instead, it is not necessarily a coincidence of timing. Depending on the cause of the pain, the belief that the pain is being healed can actually cause a reduction in the pain.
So I still don’t know why you ever thought that anything other than pain was being discussed between you and me. That isn’t where it started, and I never brought up any claims beyond that. I was always clear.
I didn't think it was about anything else than pain. The placebo surgery in the OP link IS about chronic pain.
Essentially it looks like you STILL haven't bothered to read and get a clue about what was discussed -- including, yes, the wide spectrum of such placebo effect trials; not everything is about minor pain and stuff you can deal with in an hour -- even after being told explicitly about it, but think you can berate me for not somehow knowing it should be about what you pulled out of your own imagination instead. I.e., for being on topic.
But anyway, surprising as it may sound, I haven't won Randi's million. I have no way of knowing that when you say placebo trials, not only you mean only your own arbitrary subset of them, but even exclude the ones in the OP.
It can cause a reduction in the perceived pain, without making any objective difference to its cause. Whether that's a meaningful distinction with a purely subjective symptom like pain is, I believe, the question under discussion.
Not even necessarily that. It causes a difference in reported pain. But, as I was saying, we already know that everything from wording to order choice to even the order of questions can produce a significant difference in polls about anything. Source, for example, https://methods.sagepub.com/reference/encyclopedia-of-survey-research-methods/n255.xml
"Most social scientists are aware that responses to survey questions can be significantly affected not only by how questions are worded but also by the order in which the questions are asked. Furthermore, they are generally aware that the order in which the response alternatives within a question are presented can likewise have a significant influence on survey results."
But really, it's so well known and has been known for so long, it's even been used in sitcoms:
It's played for laughs, but all the effects in there are actually straight from sociology. Reputable polling companies, as the quote above tells you, indeed are aware that answers to later questions are influenced by what you answered to previous questions. As are they of the fact that people answer differently if the wording or anything else gives them an idea of what's expected of them.
As is the fact that, as I was saying, there is a measurable bias towards responding "yes" to ANYTHING. Even without the leading questions in the skit, if you ask group A all the non-randomized "are you in favour of reintroducing national service" and group B "do you oppose reintroducing national service", the percentage of "yes" in group A will be greater than that of "no" in group B every single time. That's why in serious polls it's actually randomized whether you get form A or form B of the question.
Ditto for picking the first choices in a multi-choice question. That's what the significant influence of the order of choices is about in the above quote. If everyone gets the choices to "how do you feel about reintroducing national service" as ranging from 1. strongly support to 5. strongly oppose, you have a skew towards picking "strongly support" in the results, just because that's what was at the top.
Edit: and as I was saying before, it applies just as well to things in the past. If you poll someone about what they thought about Angela Merkel's speech last month, the above effects still apply. Your poll can't change the actual experience they had at the time (such as thinking she's full of it or not), because that kind of causality would go against the time axis. There's no way to cause an actual placebo effect, so to speak, there. But you get a difference in what they report anyway.
We also know from the cognitive dissonance studies that people even change their memory of something, to keep their mental model in line with what they want to believe. Such as, you know, wanting to believe that taking medicine will help them.
And indeed some placebo studies have asked people about expectations and such, and found that indeed what you get is a correlation between their confidence in it and the reported results. Which sure, CAN mean that really believing actually makes the placebo effect work, and it is probably one factor. But strangely enough it's also exactly the kind of correlation you'd expect from a cognitive bias and/or cognitive dissonance effect.
Coincidence? Maybe. Maybe not.
But anyway, what I'm saying, and I believe arthwollipot is saying, is that when we talk about comparing things to placebo, actually the remissions in the control group are a combination of stuff like:
- actual placebo effect, if any (as was said, it doesn't seem to work for actual illness at all)
- your own body fixing itself
- Regression toward the mean (if you do something when the pain is the worst, or generally go to the doctor when things get worse than normal, of course after a while you'll notice it became more mediocre)
- cognitive bias, if self-reporting plays any part in it
- self-selection bias in your sample
- reporting effects, like I talked about above, if self-reporting plays any part in it
Etc.
Basically, as he puts it, it's really a combination of every single variable you didn't control for.
At least in popular culture, the placebo effect is taken to cover the whole sum of those. If the control group for, say, some antibiotic trial saw x% remissions without the actual medicine, they take it to mean that OMG, placebo really cures x% of bacterial infections. Therefore, mind over body BS. Or therefore, you can go take some homeopathic remedies instead, 'cause if you believe strongly enough, it will heal you by placebo effect anyway.
When in reality, as it turned out when we had large scale meta-studies, in that case exactly 0% of it had anything to do with the placebo actually making any difference to the infection.
But anyway, what I'm saying, and I believe arthwollipot is saying, is that when we talk about comparing things to placebo, actually the remissions in the control group are a combination of stuff like:
- actual placebo effect, if any (as was said, it doesn't seem to work for actual illness at all)
- your own body fixing itself
- Regression toward the mean (if you do something when the pain is the worst, or generally go to the doctor when things get worse than normal, of course after a while you'll notice it became more mediocre)
- cognitive bias, if self-reporting plays any part in it
- self-selection bias in your sample
- reporting effects, like I talked about above, if self-reporting plays any part in it
Etc.
Basically, as he puts it, it's really a combination of every single variable you didn't control for.
Mike Hall goes into all of this over many episodes of the podcast. I'm expecting that more articles will be forthcoming. There's certainly enough material for a publishable book. But writing takes time.
If the article schedule goes on a similar track to the podcast, soon he'll explain how Ben Goldacre got it so dreadfully wrong in his book Bad Science.
It can cause a reduction in the perceived pain, without making any objective difference to its cause. Whether that's a meaningful distinction with a purely subjective symptom like pain is, I believe, the question under discussion.
I'm not willing to dismiss decades of wisdom based on one podcast:
"The placebo effect is more than positive thinking — believing a treatment or procedure will work. It's about creating a stronger connection between the brain and body and how they work together," says Professor Ted Kaptchuk of Harvard-affiliated Beth Israel Deaconess Medical Center, whose research focuses on the placebo effect.
Placebos won't lower your cholesterol or shrink a tumor. Instead, placebos work on symptoms modulated by the brain, like the perception of pain. "Placebos may make you feel better, but they will not cure you," says Kaptchuk. "They have been shown to be most effective for conditions like pain management, stress-related insomnia, and cancer treatment side effects like fatigue and nausea."
Yes, that's the kind of statement that Mike thoroughly and convincingly debunked.
ETA: And the fact that he has been going against common wisdom is not lost on him. It's why he was so very careful and thorough about going back to the original research.
Even if a placebo is taken instead, it is not necessarily a coincidence of timing. Depending on the cause of the pain, the belief that the pain is being healed can actually cause a reduction in the pain.
It can cause a reduction in the perceived pain, without making any objective difference to its cause. Whether that's a meaningful distinction with a purely subjective symptom like pain is, I believe, the question under discussion.
That's the key word. And even then it is slightly inaccurate, if you attend some of the pain clinics, they will help you understand how your mental state can affect how you cope with your pain, it isn't really the perception as much as the attention you pay to your pain.
And to add something in - remember chronic pain is vastly different to acute pain so what works with acute pain - usually a strong short dose of pain killers is very different to what will work at helping someone live with their chronic pain.
Even if a placebo is taken instead, it is not necessarily a coincidence of timing. Depending on the cause of the pain, the belief that the pain is being healed can actually cause a reduction in the pain.
No, it will affect how you deal/cope with the pain, there is no reduction in the pain itself it's your mindset that is changed by your belief not your physiology. Which of course doesn't mean someone doesn't actually "feel" better after a placebo. I like long hot baths, I would say in folk language that it helps relieve my pain, because I "feel better" or "more relaxed" but it doesn't do anything to the pain, it's a way I've learnt to relax (and now associate with feeling better) which makes me feel better even though the pain doesn't change.
Which decades of wisdom? It's been slow progress finding treatments that work for chronic pain, it's only comparatively recently that it has become a discipline/specialisation in its own right, in many countries they are well behind the ball.
Which decades of wisdom? It's been slow progress finding treatments that work for chronic pain, it's only comparatively recently that it has become a discipline/specialisation in its own right, in many countries they are well behind the ball.
If you read what was quoted from that link you would see that it is about "decades of wisdom" that suggest that the placebo effect is real and not imaginary.
You are free to provide links to research that debunks this idea but a mere podcast won't cut it.
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